Provider Demographics
NPI:1649220500
Name:MOSCOW FIRE AND HOSE COMPANY
Entity Type:Organization
Organization Name:MOSCOW FIRE AND HOSE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY-GUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-499-3519
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9020
Mailing Address - Country:US
Mailing Address - Phone:570-842-7211
Mailing Address - Fax:570-842-7137
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9020
Practice Address - Country:US
Practice Address - Phone:570-842-7211
Practice Address - Fax:570-842-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012905310001Medicaid
PA30533OtherGEISINGER HEALTH PLAN
PA005653242OtherAETNA
PA0012905310001Medicaid
P01155966Medicare PIN